CommercialCoverageMedium impact
Medical Policy Update for July 30, 2025
Blue Cross NC·NC · Cardiology·Medical Policy
Effective date
Jul 30, 2025
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated their leadless cardiac pacemaker policy to remove specific device brand names (Micra, Aveir) and replaced them with generic device categories. Single chamber right ventricular systems remain covered under specific criteria, while right atrial and dual chamber systems are considered investigational. The Paraspinal Surface Electromyography (SEMG) policy was archived.
Action Required
By July 30, 2025: Billing team must update prior authorization requests and documentation for leadless cardiac pacemakers to use generic device descriptions rather than specific brand names (Micra, Aveir). Verify that only single chamber right ventricular transcatheter pacing systems meet coverage criteria before submitting claims. Stop billing for Paraspinal Surface Electromyography (SEMG) as this policy has been archived.